Active NPI
Kelley N Martin, CRNP
- Nurse Practitioner
- Florence, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R814098
- Practice address
- 218 East Main Street
Florence, MS 39073 - Phone
- (601) 845-6602
- Fax
- (601) 845-6164
- NPI assigned
- Oct 3, 2006
- Last updated
- Feb 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R814098 | MS | Primary |
Addresses
Primary practice location
218 East Main Street
Florence, MS 39073
Mailing address
PO Box 530
Florence, MS 39073-0530
Phone (601) 845-6602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00122896 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
218 E Main St
Florence, MS 39073-6041
Phone (601) 845-6602
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R814098 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin Health Care, LLC | Current | Accepting new patients | |
| Emergency Medicine Associates of Jackson | Past | Accepting new patients |
Locations
218 E Main St
Florence, MS 39073
Phone (601) 845-6602
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Florence Family Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest W-2 Managing Employee |
Jan 1, 2008 Jan 1, 2008 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Family Medicine Physician
- Florence, MS
- NPI 1669652558
5% Or Greater Direct Ownership Interest, W-2 Managing Employee
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Florence, MS
- NPI 1669652558
-
- Emergency Medicine Physician
- Jackson, MS
- NPI 1043315906
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1710909585
-
dba Merit Health River Oaks
- General Acute Care Hospital
- Flowood, MS
- NPI 1396792032
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1306876065
-
dba AccentCare Home Health of Jackson
- Home Health Agency
- Clinton, MS
- NPI 1356482749
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708560000000",
"number": "1841384443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 530",
"city": "FLORENCE",
"state": "MS",
"postal_code": "390730530",
"telephone_number": "601-845-6602",
"fax_number": "601-845-6164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 EAST MAIN STREET",
"city": "FLORENCE",
"state": "MS",
"postal_code": "39073",
"telephone_number": "601-845-6602",
"fax_number": "601-845-6164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KELLEY",
"middle_name": "N",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2024-02-22",
"certification_date": "2024-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MS",
"license": "R814098",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00122896",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florence, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.